While psychosocial services for children with cancer and their families are available in most cancer treatment centers, this care may be enhanced and delivered with greater effectiveness with systematic assessment instruments that can accurately identify risk factors for ongoing psychosocial adjustment or difficulties. We have developed and conducted a preliminary feasibility pilot study of a 20 item screening instrument, the Psychosocial Assessment Tool (PAT) for families of children newly diagnosed with cancer. The PAT includes questions for l 0 domains of risk, based on the research literature and clinical practice: Family Structure; Family Resources; Social Support; Child Knowledge; School; Child Emotional and Behavioral Concerns; Child Maturity for Age; Marital/Family Problems; Family Beliefs; and Other Stressors. In the present study we propose to develop scoring criteria for the PAT and to evaluate it by determining its psychometric properties (short-term and 6 month test-retest reliability and concurrent, construct, and predictive validity). 140 families of children newly diagnosed with cancer at The Children's Hospital of Philadelphia (CHOP) will be recruited and asked to complete the PAT and questionnaires assessing parental, child and family functioning at diagnosis and 6 months subsequently. Data will also be obtained from oncologist and nurse ratings of family risk and function. We will also measure hospital resource utilization (e.g., social work and psychological interventions, extent/intensity of nursing/medical attention to psychosocial issues, and use of other hospital resources). An external panel of multidisciplinary experts in pediatric oncology will assist in determining the scoring and weighting of items. Our hypotheses and related statistical analyses will test associations among parent and staff assessments of family risk and the predictive ability of the PAT to identify those families with ongoing psychosocial difficulty and elevated levels of resource utilization. The PAT is novel in its brief empirical approach to determining family risk in pediatric oncology. By reliably identifying families with varying levels of risk at diagnosis we may develop subsequent interventions which match their level of need over the course of treatment.